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portant feature of life. Through a lack of courage, or through a sense of false modesty, the system of generation is looked upon as a system of shame. This impression is so fixed and grounded in the mind of youth that it is apt to dominate his mental attitude throughout life. This sex instruction, to their sons so inauspiciously begun, is then committed to haphazard sources, to servants, to old or dissolute companions, and quack literature."*
It is the duty of the medical profession, who are in a position to appreciate the necessity of such instruction, to insist that it be carried on through the proper channels, the schools, by ways and means which seem best for those expert in training the young.
Let it be taught what constitutes morality, but do not neglect the physical side of the subject. The possible consequences of transgression should also be known. I have known three girls who became pregnant in the thirteenth year and not one of them knew the nature of the sex relation.
It is not claimed that proper instruction along the above lines would remedy all the evils referred to, but for right living a knowledge as to what constitutes it is required, and when the impress is made in the right way upon the impressionable mind of youth, much good will result, and we would not hear it said, as I have heard it time and again, "I did not know that such things were.”
Alcohol and Narcotics. One of the great scourges of the earth is intemperance in the use of alcohol. This is a practice which is the direct or indirect cause of more crime, poverty, diseases and untimely death than any other one factor, and yet it is passed over in our public institutions of learning with but meagre attention, in spite of the fact that laws exist in all the states which require that such instruction shall be given. It is interesting to note that these laws, making such study compulsory, have been secured almost wholly by the efforts of women, led by the late Mrs. Mary H. Hunt, of Boston, who for twenty years gave her whole time and fortune to the task. Physicians as a body have done but little in this direction.
I judge that this study is neglected from the knowledge of the subject possessed by the New York City finished product at the fifteenth or sixteenth year of age. In order to give the child what he has a right to demand, and for his own interest
and his own protection, he should know the effects of alcohol, immediate and remote, as well as he knows the multiplication table. I am not advocating prohibition, or that it be taught. I speak for the boy and girl in a personal and selfish sense only.
An intimate association with a great many people in an active life for many years has resulted in the formation of a few additional convictions regarding educational matters. One conviction is that we are being educated to a danger point. State colleges and schools, semi-private and so-called private, are founded and endowed. Scholarships are supplied, not because of the law of supply and demand, but because some rich man or woman desires to ease a conscience or erect a lasting monument, with the result of making a certain proportion of the incompetent still more unfit. The next step which is in order, and not far in the distance, will be the offering of gratuities to students because students must be had. This factor in the life of the body politic, together with a spirit that exists in our public schools and in schools generally, is doing much to disorganize society. This spirit or sentiment is a species of madness and is a distinct Americanism. It is the desire for end results. It is the American spirit of "getting there" regardless of the method. We see it in our public life. We have all had ample demonstration of its operative possibilities in the business and financial world during the past year. This sentiment in the schools has been deplored by as eminent a teacher as Dr. J. E. Russell, of the New York Teachers College. This system of instruction appears to consist of a process of imparting specific information which is to be remembered, the end results being answers to questions. Actual knowledge, founded and acquired through processes of the reasoning faculties, is not particularly apparent in the finished product. I know not a few who show a lack of mental force, defective concentration and an absence of knowledge which should have been acquired during the training of this higher function.
The system of prizes and rewards for the best recitations, or set of answers in a given subject, is a bad one, as it overtaxes the pupil and it usually means a matter of memory. For certain excellence at recitation a boy patient, whom I was obliged to take out of a private school, received daily a red card. When he had five red cards he received a large yellow card. I asked him what the yellow card stood for. He did not know. He had worked so hard to get these yellow cards, the significance of which he did not know, that I was obliged to take him from school. He could scarcely hold a pack of these yellow cards in his hands because of the chorea which was present.
By suggestion and encouragement, if not by direct advice, the young of our schools are under the stress of a constant incentive to strain after greatness. Emulation is in the school air. Every boy in some way is made to believe that in him is the metal from which Presidents of the United States are fashioned; that out of such material as the great financiers, lawyers, physicians and teachers are moulded; that he ought to be great, and if he gets his lessons by some means or other, he is taking his first step toward so-called greatness. I look upon it as most unfortunate for the boys of this country that Abraham Lincoln split rails and was born in a log-cabin; that General Grant was a tanner; that Garfield drove mules before a canal boat, and that Russell Sage sold newspapers. In defence of this teaching it is claimed that high ideals should be placed before the young. The highest ideals do not have end results in the acquirement of wealth or power or position. Bringing a child up in an atmosphere thus charged is the inevitable cause of much disappointment, suicide and life failures, and for the reason that it is impossible to build a $10,000, $20,000 or $40,000 a year intellect in a two-dollar a day brain. This spirit, with the encouragement from all sources -endowments, scholarships and rich men's colleges—toward so-called higher education, induces youths to spend years in striving and end in failure more or less complete. This overeducation of the unfit brings forth tastes, habits and desires of which he should not know, and is the cause of more thieving, gambling and all around dishonesty than is well appreciated. When position and wealth or reasonable competency do not follow by legitimate means, others are readily seized upon.
The labor question in this country is a most serious one. In times of usual prosperity it is well-nigh impossible to get workmen. During building operations which I had under way a few years ago, from $5 to $8 a day for a so-called eighthour day was paid. In periods of depression, skilled laborers fare no worse than others. Among the boys whom I have known intimately during the past twenty years, sons of carpenters, shoemakers, plumbers, bricklayers, etc., I have known not one who wished his occupation to be that of his father. These boys would all be lawyers, bank presidents, physicians, etc., and, sorry to relate, some of them became lawyers or physicians. No bank presidents, but poorly paid bookkeepers they are today. None would be a wage-earner with the father, because of the efforts to make him think above it. All the professions are overcrowded with the disappointed unfit. I know physicians whose income from their practice is less than $1,000 a year. Ten per cent. of those graduated in medicine fail to make a living and seek other occupation. A few years ago, when I was experiencing difficulty in getting workmen at $5 a day, a lawyer friend advertised in a daily paper for clerks somewhat familiar with legal work, to do copying of a certain nature at a salary of $8 a week. Among those who applied were seventeen lawyers, who had been admitted to the bar of New York State. The great majority of bookkeepers, clerks and small business men and many male teachers have less earning capacity than the man with a trade.
I would impress upon teachers and the Board of Education this thought: "That labor is the inevitable lot of the majority, and that the best education is that which makes labor the most productive.” For the boy who is to go out and become a member of the working class, as millions must, I would have inserted somewhere in the curriculum, somewhere between the Spanish history period and the elocution period, a few minutes devoted to a talk on honest toil and the nobility of labor, and that the only dishonorable work is that which is badly done. I would have boys taught reading, writing and arithmetic and the rudiments of a trade. Somewhere between the zoology and commercial law period I would have the girl who is to bring up a family of children, and who will have to do her own housework, get more than a passing glance at physiology, cooking, sewing and food values.
At this moment these 18,000,000 boys and girls in the public schools are not being furnished the physical advantages and protection that they have a right to demand. They are not being taught how to live.
And if we judge of our public school educational course according to the degree with which it discharges its function, we are forced to admit that it fails in its function.
AN ANALYSIS OF FOUR HUNDRED CASES OF EPI
DEMIC MENINGITIS TREATED WITH THE ANTI-
BY SIMON FLEXNER, M.D.,
JAMES W. JOBLING, M.D.,
(From the Rockefeller Institute for Medical Research, New York.)
We have already reported concerning the effects of the employment of an antimeningitis serum, prepared in the horse by inoculation of diplococcus intracellularis and its products, upon the course and termination of a small number of cases of epidemic meningitis.* The results first presented were, on the whole, so satisfactory that we believed the employment of the serum on wider scale not only justified but clearly called for; and we are now in position to present a second series of figures which are based upon an analysis of about 400 cases of epidemic meningitis in which the serum has been used.
The cases of meningitis upon which this analysis rests have arisen in different and widely separated parts of the United States and Canada, and in Great Britain. They have occurred sometimes as small epidemics, as in Castalia and Akron, O., in Porterville, Cal., and, possibly, in other places in the United States, and in Belfast, Ireland, and Edinburgh, Scotland; and sometimes as sporadic outbreaks of considerable extent, as in Cleveland, Boston, Baltimore, Cincinnati and Philadelphia. Moreover, it is now evident that so-called epidemic meningitis is widely prevalent throughout the United States, and it would appear to be questionable whether any parts are really free from the disease. In view of the fact that we have demanded that the bacteriological diagnosis be made in every case of meningitis for which we have supplied the serum, and which we have accepted for our analysis, and that in doubtful instances we have
* Journal of Experimental Medicine, 1908, x, No. 1. Independent publications have been made by Robb, British Medical Journal, February 15, 1908; by Dunn, Boston Medical and Surgical Journal, March 19, 1908; and by Chase and Hunt, Archives of Clinical Medicine, April, 1908.